Vascular cognitive impairment in first ever ischemic stroke survivors

Stroke and transient ischemic attacks (TIA) are highly prevalent in Pakistan. Post stroke dementia (PSD) is one of the main causes of dependency in survivors and includes any dementia after a stroke, irrespective of its cause, which includes vascular, degenerative, or mixed. Many Independent survivors have residual physical or cognitive deficits, or behavioral changes which can affect family life and have professional consequences. Study design: Cross sectional study at Department of Neurology CMC Hospital Larkana from Aug-2014 to Jan-2015 to find out frequency of dementia in first ever ischemic stroke patients, its severity and outcome. Methods: Study approved from ethical review committee of the institute. Patients 30-60 years of age, of either gender, previously non-demented with first episode of ischemic stroke were included in this study after informed consent. Patients of Hemorrhagic stroke, Parkinson’s disease, Terminal cancers and those on steroids were excluded. Stroke confirmed by CT scan brain/ MRI showing new infarcts. Dementia was defined as per MMSE dementia interview at baseline and 3 months of follow up. Score of \u3c23 indicated cognitive impairment. Activity of daily living was assessed by AD8 screening interview. Score \u3e2 indicated impairment in activity of daily living. Results: 120 patients were included in the study during 6 month period with mean age of 54(±3.4) years. Among them 74 were males and 46 were females. 52 (43.33%) patients had a lacunar stroke, 43(35.8%) a MCA infarct, 13(10.83%) with ACA infarct, 12 (10%) a posterior circulation stroke. Among vascular risk factors hypertension present in 32 (26%), diabetes in 22(18.3%), atrial fibrillation in 11(9.16%), previous myocardial infarction 10( 8.33%) and history of transient ischemic attack 34(28.33%). Their medical history, neurological deficit, activity of daily living, a blood screen and extent of vascular territory of the stroke were recorded. MMSE at 3 month of stroke follow up performed which revealed \u3c23 score among 33(26%) patients. The activity of daily living was impaired among the demented patients. Recall, language and attention was impaired more than registration and orientation. Discussion: Patients with PSD have high mortality rates and are likely to be functionally impaired. The progressive decline of recall and forgetfulness observed in our study severely affect the activity of daily living. The best way to prevent dementia is preventing vascular risk factors and the stroke by medications and follow up. Conclusion: Stroke patients should be assessed with dementia and monitored regularly with structured MMSE and activity of daily living as part of routine check up to prevent mortality and morbidity in stroke survivors